The Care Quality Commission
  • Residential substance misuse service

Cassiobury Court

Overall: Requires improvement read more about inspection ratings

Richmond Drive, Watford, Hertfordshire, WD17 3BG (01923) 804139

Provided and run by:
Cassiobury Court Ltd

All Inspections

27-28 November 2018

During a routine inspection

We rated Cassiobury Court as requires improvement because:

  • The ligature risk assessment did not include risks in corridors and did not capture all other ligature risks. The mitigation was not adequate so we were not assured of clients safety.
  • The alcometer and oxymeter had not been calibrated.
  • The qualified nurse received regular managerial supervision but was not having clinical supervision as appropriate to their role.
  • Cassiobury Court had a small number of clients who had self-harmed within the last 12 months. The service had an admissions criteria and the admissions policy highlighted a range of high risk issues that were considered to be unsuitable for acceptance into the service. The service was accepting admissions who were identified as unsuitable in the admissions criteria.
  • At the time of the inspection, the mixed sex accommodation was not split into male and female areas, although the manager said that if this was requested by a client then they would accommodate this. The current arrangement meant that clients may have their privacy or dignity compromised. The potential risk was not mitigated by risk assessments. The service did not have a lone working policy, there was no alarm system and we were not assured that staff and clients could summon help quickly in an emergency.
  • The pre-admissions assessment was shared with managers and staff via a social media application on personal mobile phones. The service did not have processes in place to monitor the security of the information.

However:

  • Staff had completed training in the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff that we spoke with gave examples of how they would support clients who lacked capacity.
  • Staff provided a range of psychological therapies recommended by The National Institute for Health and Care Excellence. These included cognitive behavioural therapy and group therapy. Some of the topics covered in group therapy were mindfulness, meditation, reflection and relapse prevention, phototherapy, tai chi and yoga. Clients were given some choice about which therapies they accessed.
  • We observed that staff spoke to clients with patience, kindness and respect. Clients that we spoke with told us consistently that staff were empathic and respectful and treated them with dignity and kindness. There was always a staff member available to speak to and they provided clients with practical and emotional support.
  • Managers had the skills knowledge and experience to carry out their role effectively. They had a good understanding of the organisation that they managed and were clear and committed to achieving high quality care and treatment.

9 October 2017

During a routine inspection

We do not currently rate independent standalone substance misuse services.

We found the following issues that the service provider needs to improve:

  • The clinic room was very small and not fit for purpose. There was no fridge and no examination couch. Physical examinations took place in patients’ bedrooms.

  • Ten out of 17 staff had completed mandatory training, this included safeguarding of vulnerable adults.

  • During the inspection we reviewed the incident log. Since January 2017 there had been 29 incidents recorded with the highest number of incidents being falls. Actions had not been recorded in 14 out of 29 cases.

  • The supervision policy stated that staff should receive supervision every four to six weeks. We sampled the supervision records of six staff and found that one had received supervision every four to six weeks. Staff that we spoke with told us that supervision was not regular.

  • There had been no complaints received between August 2016 and July 2017. However staff informed us of two very recent complaints. Staff told us they did not always respond to complaints in a timely manner. They were working to improve this.

  • Staff had not received training in the Mental Capacity Act and staff had a limited knowledge of capacity issues.

  • There was no training budget for leadership training for managers.

However, we also found the following areas of good practice:

  • Managers estimated the number of staff on a ratio of six clients to one staff member and adjusted this according to client numbers and needs.

  • Of the six care records reviewed, all contained up to date, holistic, personalised and recovery orientated care plans. Clients strengths and goals were identified and ongoing discussion in those areas was recorded. Observation levels were recorded and reviewed as clients progressed through their treatment plans.

  • In the last 12 months, 100% of eligible staff had received an appraisal.

  • All of the clients that we spoke with told us that staff were kind compassionate and supportive. Clients statedthat they felt safe within the service.

  • The service provided post discharge telephone support and an aftercare service for a period of 12 months after clients had been discharged.

  • There was access to a wide variety of activities and groups throughout the day and during the evening seven days per week.

  • Staff knew who the most senior managers in the organisation were. Senior managers visited the organisation at least fortnightly for service meetings and quarterly audit meetings.

6 July 2016

During a routine inspection

We do not currently rate independent standalone substance misuse services.

We found the following issues that the service provider needs to improve:

  • Staff had a limited understanding of safeguarding procedures, and 15 staff had not completed current training.

  • Some care plans did not contain client signatures, making it unclear if they had received copies of their recovery goals.

  • Some risk assessment documents did not contain staff signatures.

However, we found the following areas of good practice:

  • The service provided a variety of treatment and therapy sessions, with care and support plans tailored to individual clients’ needs. Treatment was provided in groups and one to one sessions.

  • Clients could access external support services such as Alcoholics Anonymous and Narcotics Anonymous in addition to the daily treatment programme.

  • Staff supported clients to develop recovery goals collaboratively, focussing on coping strategies and discharge planning.

  • Staff supported clients to access and integrate into the local community. This was incorporated into the daily activity programme. Clients also had access to a courtyard and garden areas.

  • Client bedrooms and communal areas were decorated and furnished to a high standard.

10 January 2014

During a routine inspection

We spoke with three people who used the service. They told us that they were fully involved in deciding the course of their rehabilitation. One person told us, "They ask what you want or don't want and explain what they can offer. It is then entirely up to you. They don't force anything on you."

People told us that they were very happy with the care and treatment they received and knew that their plans were personalised to them. One person told us, "The staff are great. They are easy to talk to and are very helpful. They treat me as an individual."

On the day of our inspection the centre appeared clean and bright. People told us that their rooms were cleaned and their bedding was changed regularly. One person told us, "They clean my room thoroughly every week."

We saw from recruitment files we looked at that people only started work after a full criminal records check had been received and they had demonstrated that they were legally entitled to work in the United Kingdom.

We saw that people's records were kept on a shelf in the manager's office. We noted that when the office was unoccupied it was locked. This meant that the records could be accessed only by people who were authorised to do so.